胃癌術後10年以後の再発3症例―異時性重複癌も含めて

Three Cases of recurrent Gastric Cancer more than Ten Years after the Initial Operation

　胃癌手術後，10年以上経過して再発した早期胃癌2症例とpm癌1症例を経験したのでこれを報告する．

症例

〔症例1〕

患　者：81歳　女性 主　訴：心窩部重圧感 現病歴：食後の心窩部重圧感が5～6年つづいてあり，昭和医大病院で精査を受けて胃潰瘍と診断され，1959年1月（当時55歳）同大学病院外科に入院した．

　Recently, we have encountered 3 cases of recurrent cancer more than ten years after the initial operation.

　Case 1. A 81-year-old female had undergone gastrectomy in June 1959. The resected specimen had shown Ⅱb type of early cancera long the lesser curvature. Microscopically the oral margin had not been free from cancerous infiltration. Then 16 years after surgery, the recurrence of cancer was recognized extending from the gastro-duodenal stump up to the esophageal mucosa. She had second operation in March 1975. This case is classified as the stump recurrence type.

　Case 2. A 49-year-old female had undergone radical gastrectomy in June 1965. Microscopic study had confirmed the type Ⅱa+Ⅱc of early gastric cancer. Ten years after the operation, recurrence of the cancer was diagnosed by endoscopic biopsy. The rest of the stomach was resected in June 1975, the specimen demonstrating cancerous infiltration on the abdominal esophagus away from the stump. This recurrent pattern is considered to be nonsimultaneous multiple cancer.

　Case 3. A 68-year-old male had undergone absolute curative operation in Oct. 1960, and the lesion had been confirmed as the type pm of advanced gastric cancer. The recurrence of cancer was found in Oct. 1975, or 15 years after the first operation. As in Case 2, this recurrent pattern is considered the nonsimultaneous multiple cancer.

　These three cases seem to show that the recurrence of cancer following the operation of early gastric cancer takes relatively long time, and for estimating the operative cure rate 10-year survival rate seems to be more reasonable than 5-year survival rate. As advanced gastric cancer tends to show relatively short recurrent period after surgery, Case 3 seems an extremely rare one, which developed apparent recurrence after more than ten years.